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Checkup on health care reform

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“You don’t know you don’t know until you know it.” Guest speaker Larry Kocot’s observation summarized the panel discussion during “Health Reform Check-Up: Learning from the Start-Up of the Medicare Prescription Drug Program” sponsored by Minnesota Blue Cross/Blue Shield and the Humphrey School Center for Politics and Governance at the Cowles Auditorium Tuesday afternoon, December 3, 2013. As a “key member” of the Bush administration’s Medicare D implementation program, Kocot’s remark acknowledged the difficulties the Obama administration has encountered in implementing its Affordable Care Act.

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Though he, panelists Scott Keefer (Blue Cross/Blue Shield), Debra Holmgren (Portico Healthnet), Brian Beutner (MNsure), Lucinda Jesson (Minnesota Department of Human Services), and moderators Lawrence Jacobs (Humphrey Center Director) and David Hage (Star Tribune) identified many causes for ACA’s rocky start—not enough time, not the right metrics, not enough involvement by brokers, physicians and pharmacists—the primary reason seemed to be a lack of communication. “People don’t read their insurances” because the language of the Affordable Care Act is “too damn confusing” Kocot lamented. Keefer agreed that the bridge to successful health care reform has been blocked so far because “communication hasn’t been that great up to now.”

Enrollment in Minnesota’s health care plan, however, seems to be successful despite the communication problems. Beutner exclaimed that “We are driving across the bridge today. Our bridge is complete.” Holmgren guardedly said about the startup, “Right now it’s hard,” but she was gratified “to have improvement in [Minnesota’s] health care …becoming part of basic needs coverage.” But to escape “the [continuing] noise at such a technical level” according to Beutner, he and his fellow health care experts “will have to pivot the discussion to how well [the new health care plan] works.”

That won’t be easy. Beyond platitudes about political infighting, (“I’ve never seen it this bad in Washington” said Kocot) and bland reassurances (“It happens with every rollout”), ACA providers need to find “anybody who could explain this to people.” Yes, these seasoned health reform professionals have endured arbitrary criticism for “playing [the operational process] out in public,” but as Keefer said, they need “to get beyond the operational realm” and realize that “this [i.e. health care reform] is about people.” Finding navigators, whether insurance brokers or government agents, who enable undecideds to appreciate the value of Obamacare must become a priority or “we’re never going to solve these things.” The apparent lack of understanding of this critical factor displayed yesterday recalls manager Casey Stengel’s famous quote regarding his New York Mets, “Can’t anybody here play this game?”

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